HomeMy WebLinkAboutAgreement A-19-444 for Professional Medical Services.pdf-1-
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MASTER AGREEMENT FOR THE PROVISION OF SPECIALTY AND PRIMARY PROFESSIONAL
MEDICAL SERVICES AND EMERGENCY CARE
THIS AGREEMENT is made and entered into this 10th day of September, 2019, by and between
the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
"COUNTY", and each CONTRACTOR, listed in Exhibit 1 “List of Contractors” (attached hereto and by this
reference incorporated, herein) and collectively herein referred to as “CONTRACTOR/S”, and such
additional CONTRACTOR/S as may, from time to time during the term of this Agreement, be added by
COUNTY. COUNTY and CONTRACTOR/S are referred to herein, collectively, as "Parties", or “Party”
individually.
W I T N E S S E T H:
WHEREAS, the COUNTY is responsible for the provision of medical services necessary to avoid
suffering or endangerment to life or health to indigent lawful residents of the COUNTY, who are not
otherwise relieved by their family and friends, by their own means or by state hospitals or other state or
private institutions under Welfare and Institutions Code section 17000, and thereby has adopted and
directly administers a Medically Indigent Service Program “MISP” (attached hereto as Exhibit 2 and
incorporated by this reference, herein) for eligible individuals hereinafter referred to as “MISP beneficiary” or
“MISP beneficiaries”; and
WHEREAS, the COUNTY desires to make available to MISP beneficiaries specialty and adult
primary professional medical services, and emergency care “Professional Medical Services” provided in
Exhibit 3 (attached hereto and incorporated by this reference, herein); and
WHEREAS, CONTRACTOR/S have the expertise and staff with the proper licensure, certification,
and education to assure they are competent and possess the skills and experience appropriate and have
the desire to provide Professional Medical Services, identified in Exhibit 3, herein; and;
Now, therefore, COUNTY and CONTRACTOR/S, in consideration of the covenants, terms, and
conditions herein contained, the Parties hereto agree as follows:
1.RESPONSIBILITIES OF CONTRACTOR/S
A.Specialty and Adult Primary Professional Medical Services: CONTRACTOR/S
shall exclusively perform specialty and adult primary professional medical services, identified in Exhibit
Agreement No. 19-444
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3, to any MISP beneficiaries who do not qualify for Medi-Cal and are in need of such service/s to avoid
suffering or endangerment to life or health in exchange for COUNTY’S payment under Section 3,
Compensation and Invoicing, below. CONTRACTOR/S shall not perform any non-emergent specialty
and adult primary professional medical services to any MISP beneficiary until the COUNTY’S
Department of Public Health “DPH” Director, or his/her designee, DPH’s MISP Administrator, or third-
party vendor confirms to CONTRACTOR/S in writing or through the COUNTY’S electronic health
tracking system (to which CONTRACTOR/S shall have read-only access), that such person is currently
enrolled in the COUNTY’S MISP.
B. Standard of Medical Care: CONTRACTOR/S must perform specialty and adult
primary professional medical services, in Exhibit 3, in accordance with acceptable medical standards
within Fresno County, California.
C. Licenses and Certification: CONTRACTOR/S shall provide only qualified
personnel who are credentialed by Community Medical Centers “CMC” and maintain all required
licenses and board certificates and registrations necessary for the provision of services under this
Agreement, for each particular specialty/area each employee practices, required by the laws and
regulations of the Federal, State of California, and/or local governments, including any other applicable
government agency or non-profit organization, throughout the Term of this Agreement as set forth in
Section 4, A, below.
D. Emergency Care: CONTRACTOR/S acknowledge and agree that emergency
care means:
1) A medical condition (including emergency labor and delivery) manifesting
itself by acute symptoms of sufficient severity, including sever pain, such that the absence of immediate
medical attention could reasonably be expected to result in any of the following:
a. Placing the patient’s health in serious jeopardy;
b. Serious impairment to bodily functions; or
c. Serious dysfunction to any bodily organ or part.
(Welfare & Institutions Code, §14007.5, subdivision (d); 22 C.C.R. §51056, subdivision (b); 42 U.S.C.
§1396b, subdivision (v)(3); and 42 C.F.R. §440.255)
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E. Emergency Care Services: CONTRACTOR/S will only be eligible to receive
compensation from COUNTY for providing emergency under Section 3, herein:
1) After they first seek reimbursement for individuals who qualify for Medi-Cal
or Restricted Medical;
2) The person who receives emergency care, or the person’s authorized
agent, applies for MISP no later than thirty (30) calendar days from the first date he/she receives the
care (in accordance with the “Certification Period” in the MISP, Exhibit 2; and
3) The COUNTY determines that such person would have qualified as a
MISP beneficiary at the time the emergency was provided under the eligibility requirements within
Exhibit 2.
F. Medi-Care/Medi-Cal Certification and Accreditation: CONTRACTOR/S
acknowledge that all medical staff are able to participate in the Medi-Care and Medi-Cal (MAGI and
Non-MAGI) programs under Titles XVIII and XIX of the Social Security Act, and will continue to be able
to participate in the Medicare and Medi-Cal (MAGI and Non-MAGI) programs throughout the Term set
forth under Section 4, A, below.
G. Professional Medical Services: CONTRACTOR/S acknowledges and agrees that
this Agreement is only for the provision of professional medical services in Exhibit 3. Furthermore, no
compensation shall be provided to CONTRACTOR/S under Section 3 below, for any other Professional
Medical Service as noted in Exhibit 3, unless otherwise mutually agreed to in writing by COUNTY’S
DPH Director and CONTRACTOR/S as noted in Exhibit 3.
H. Service Performed at CMC Facilities: CONTRACTOR/S shall exclusively provide
services at CMC and its affiliated hospitals and facilities (attached hereto as Exhibit 4 and incorporated
by this reference, herein) to MISP beneficiaries. Furthermore, no compensation shall be provided to
CONTRACTOR/S under Section 3 below, for any services provided at non-CMC affiliated hospitals,
facilities, and/or offices
I. Referral Comprehensive Inpatient Hospital and Outpatient Clinic Services: To the
extent CONTRACTOR/S determines that an MISP beneficiary needs hospital or outpatient clinic facility
services or other services solely provided by or in conjunction with CMC, CONTRACTOR/S shall refer
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the MISP beneficiary to CMC to obtain such necessary services.
J. Financing: Except for compensation under Section 3 below, CONTRACTOR/S
shall, at their own expense, be responsible for financing their operation and capital expenses and cash
flow requirements in providing services herein.
K. Equipment and Supplies: CONTRACTOR/S shall, at their own expense, ensure
that they have the necessary medical equipment, supplies, and pharmaceuticals when providing
Professional Medical Services, herein, including emergency care to the extent permitted under Sections
1, D, and 1, E, above.
L. No Right to Select MISP Beneficiaries: CONTRACTOR/S shall not have the right
to select the persons who may enroll in the COUNTY’S MISP.
M. Multilingual Services: CONTRACTOR/S shall maintain an appropriate capability
for communicating with MISP beneficiaries who are hearing impaired, non-English speaking and/or
limited English speaking to the extent required by law and to the extent reasonably required to provide
such Specialty Services.
N. No Treatment Permitted: CONTRACTOR/S shall not provide treatment to any
person under this Agreement if such person:
1) Is not a MISP beneficiary;
2) Is not in need of Professional Medical Services as provided in Exhibit 3 to
avoid suffering or endangerment to his/her life or health;
3) Seeks a medical service that has not been mutually agreed upon in writing
between CONTRACTOR/S and COUNTY’S DPH Director, and that is a Medi-Cal covered Service; or
4) Seeks a medical service prohibited under the MISP, Exhibit 2.
O. Compliance with Legal Requirements: In providing Professional Medical Services
as set forth in Exhibit 3, herein, and emergency care as set forth in Sections 1, D, and 1, E, above,
CONTRACTOR/S shall provide such services in accordance with all applicable laws and regulations of
the Federal, State of California and local governments, including, but not limited to, any binding relevant
case law.
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2. RESPONSIBILITIES OF COUNTY
A. Administrative Services: Throughout the Term of this Agreement set forth in
Section 4, A, COUNTY will be solely responsible for determining who is eligible to enroll in MISP (see
MISP criteria, Exhibit 2). In doing so, COUNTY shall enroll persons in MISP either through its electronic
health tracking system or through a third-party vendor. COUNTY shall provide CONTRACTOR/S with
read-only access to its electronic health tracking system, shall provide CONTRACTOR/s with the
contact information for the DPH MISP Administrator and/or third-party vendor so that CONTRACTOR/S
may verify who is currently enrolled in MISP prior to conducting non-emergency Professional Medical
Services, herein, or after conducting emergency services, herein. For purposes of this Agreement,
COUNTY’S DPH Director, or his/her designee, DPH’s MISP Administrator, or third-party vendor shall
confirm in writing or through the COUNTY’S electronic health tracking system to CONTRACTOR/S
whether a person is currently an MISP beneficiary who would qualify for MISP-covered services under
Exhibit 2.
B. Emergency Care: In the event CONTRACTOR/S determines that a person does
not qualify for Medi-Cal or Restricted Medi-Cal, but CONTRACTOR/S perform emergency care, as
defined in Section 1, D, above, to such person, the person receiving such emergency care shall submit
an MISP application to COUNTY within thirty (30) calendar days of the first day he/she receives such
care. COUNTY’S DPH Director, or his/her designee, shall promptly thereafter determine whether such
person would have qualified for MISP (under Exhibit 2) at the time he/she received such emergency
care, COUNTY shall inform CONTRACTOR/S in writing and compensate CONTRACTOR/S for
providing such service in accordance with Section 3, below.
3. COMPENSATION AND INVOICING
A. CONTRACTOR/S Reimbursement for Specialty and Adult Primary Professional
Medical Services:
1) Negotiated Service Rates: For the Term of this Agreement set forth in
Section 4, A, Specialty and Adult Primary Professional Medical Services rendered hereunder by
CONTRACTOR/S to MISP beneficiaries shall be reimbursed according to the negotiated fee for service
rates in Exhibit 5 (attached hereto and incorporated by this reference, herein).
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2) Share of MISP Beneficiary Cost will be Deducted: MISP beneficiaries
between the income range of 139% to 224% of the federal poverty level as set forth in the COUNTY’S
MISP, Exhibit 2 and who meet the other MISP eligibility criteria, are permitted to obtain necessary
specialty and adult primary professional medical services under the MISP, if they pay for a certain share
of the cost as set forth in the COUNTY’S MISP (see Pages 5 to 6 in Exhibit 1). CONTRACTOR/S shall
be responsible to obtain the MISP beneficiaries share of cost, if it provides specialty and adult primary
professional medical services to MISP beneficiaries, herein. COUNTY shall deduct the MISP
beneficiaries’ share of cost from invoices provided by CONTRACTOR/S under this Agreement.
3) Compensation Contingencies: CONTRACTOR/S shall only be entitled to
reimbursement for specialty and adult primary professional medical services under these Sections 3 A,
3 B, and 3C if:
a. The specialty and adult primary professional medical services
provided to MISP beneficiaries are medically necessary to avoid suffering or endangerment to life or
health;
b. Prior to providing comprehensive non-emergency specialty and
adult primary professional medical services, CONTRACTOR/S is notified by COUNTY in writing or
through COUNTY’S electronic health tracking system that the person to receive such service is enrolled
in the MISP and, therefore, qualified to receive such care;
c. The MISP beneficiary does not qualify for Medi-Cal; and
d. Prior to providing non-emergency specialty and adult primary
professional medical services, written authorization is obtained from COUNTY to perform the particular
service.
B. CONTRACTOR/S Reimbursement for Emergency Care:
1) Negotiated Service Rates: For the Term of this Agreement set forth in
Section 4, A, below, emergency care rendered hereunder by CONTRACTOR/S to MISP beneficiaries
shall be reimbursed according to the negotiated rates in Exhibit 5.
2) Share of MISP Beneficiary Cost will be Deducted: MISP beneficiaries
between the income range of 139% to 224%of the federal poverty level (and who meet the other MISP
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eligibility criteria) are permitted to obtain emergency care under the MISP if they pay for a certain share
of the cost as set forth in the COUNTY’S MISP (see Pages 5 to 6 in Exhibit 2). CONTRACTOR/S shall
be responsible to obtain the MISP beneficiaries share of cost, if it provides emergency care to MISP
beneficiaries, herein. COUNTY shall deduct the MISP beneficiaries’ share of cost from invoices
provided by CONTRACTOR/S under this Agreement.
3) Compensation Contingencies: CONTRACTOR/S herein, shall only be
entitled to reimbursement for emergency care under this Section 3, B if:
a. The person who received emergency care, or his/her authorized
agent, applies for MISP no later than thirty (30) calendar days from the first date he/she receives
emergency care (in accordance with the “Certification Period”) in the MISP, Exhibit 2; and
b. The COUNTY determines that such person would have qualified to
enroll in MISP at the time the emergency care was provided under the MISP eligibility requirements in
Exhibit 2.
c. Specialty and adult primary professional medical providers will
determine appropriateness of referral of specimens and biopsies to CONTRACTOR pathologists as
required by their professional medical services rendered to MISP beneficiaries. CONTRACTOR
pathologists do not determine provision of services to MISP beneficiaries, but work in conjunction with
the specialty and/or adult primary professional medical providers.
4) Maximum Compensation: In no event shall total compensation and any
other payment for any service performed under this Agreement be in excess of Six Million, Eight
Hundred Thirty-Seven Thousand, Nine Hundred Fifty-Nine Dollars ($6,837,959) for the entire three (3)
year period of this Agreement. COUNTY agrees to provide CONTRACTOR/S with written notice, in
accordance with Section 11 below, when it has expended costs under this Agreement in the amount of
eighty-five percent (85%) of the maximum compensation limit for the base three (3) year period, so that
COUNTY may take necessary action to either amend this Agreement to increase the maximum
compensation limits herein or terminate this Agreement pursuant to Section 4, A, below.
a. If this Agreement is extended for an additional one (1) year period
after the first three (3) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
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compensation and any other payment for the services performed under this Agreement be in excess of
Nine Million, One Hundred Seventeen Thousand, Two Hundred Seventy-Nine Dollars ($9,117,279) for
the entire four (4) year period of this Agreement. If this Agreement is extended for an additional one (1)
year period after the first three (3) years of this Agreement, pursuant to Section 4, A, below, COUNTY
agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below, when it
has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the four (4) year period of the Agreement.
b. If this Agreement is extended for an additional one (1) year period
after the first four (4) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Eleven Million, Three Hundred Ninety-Six Thousand, Five Hundred Ninety-Nine Dollars ($11,396,599)
for the entire five (5) year period of this Agreement. If this Agreement is extended for an additional one
(1) year period after the first four (4) years of this Agreement, pursuant to Section 4, A, below, COUNTY
agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below, when it
has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the five (5) year period of the Agreement.
c. If this Agreement is extended for an Additional one (1) year period
after the first five (5) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Thirteen Million, Six Hundred Seventy-Five Thousand, Nine Hundred Eighteen Dollars ($13,675,918) for
the entire six (6) year period of this Agreement. If this Agreement is extended for an additional one (1)
year period after the first five (5) years of this Agreement, pursuant to Section 4, A, below, COUNTY
agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below, when it
has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the six (6) year period of the Agreement.
d. If this Agreement is extended for an Additional one (1) year period
after the first six (6) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
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Fifteen Million, Nine Hundred Fifty-Five Thousand, Two Hundred Thirty-Eight Dollars ($15,955,238) for
the entire seven (7) year period of this Agreement. If this Agreement is extended for an additional one
(1) year period after the first six (6) years of this Agreement, pursuant to Section 4, A, below, COUNTY
agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below, when it
has expended costs under this Agreement in the amount of eighty-five percent (85%) of the maximum
compensation limit for the seven (7) year period of the Agreement.
e. If this Agreement is extended for an Additional one (1) year period
after the first seven (7) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Eighteen Million, Two Hundred Thirty-Four Thousand, Five Hundred Fifty-Eight Dollars ($18,234,558)
for the entire eight (8) year period of this Agreement. If this Agreement is extended for an additional one
(1) year period after the first seven (7) years of this Agreement, pursuant to Section 4, A, below,
COUNTY agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below,
when it has expended costs under this Agreement in the amount of eighty-five percent (85%) of the
maximum compensation limit for the eight (8) year period of the Agreement.
f. If this Agreement is extended for an Additional one (1) year period
after the first eight (8) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Twenty Million, Five Hundred Thirteen Thousand, Eight Hundred Seventy-Seven Dollars ($20,513,877)
for the entire nine (9) year period of this Agreement. If this Agreement is extended for an additional one
(1) year period after the first eight (8) years of this Agreement, pursuant to Section 4, A, below,
COUNTY agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11 below,
when it has expended costs under this Agreement in the amount of eighty-five percent (85%) of the
maximum compensation limit for the nine (9) year period of the Agreement.
g. If this Agreement is extended for an Additional one (1) year period
after the first nine (9) years of this Agreement, pursuant to Section 4, A, below, in no event shall total
compensation and any other payment for the services performed under this Agreement be in excess of
Twenty-Two Million, Seven Hundred Ninety-Three Thousand, One Hundred Ninety-Seven Dollars
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($22,793,197) for the entire ten (10) year period of this Agreement. If this Agreement is extended for an
additional one (1) year period after the first nine (9) years of this Agreement, pursuant to Section 4, A,
below, COUNTY agrees to provide CONTRACTOR/S with written notice, in accordance with Section 11
below, when it has expended costs under this Agreement in the amount of eighty-five percent (85%) of
the maximum compensation limit for the ten (10) year period of the Agreement.
5) Invoicing: After CONTRACTOR/S renders Professional Medical Services
(or other medical service that has been mutually agreed to in writing by COUNTY’S DPH Director and
CONTRACTOR/S as noted in Exhibit 3) to MISP beneficiaries, and meet the contingencies in Sections
3, A – 3, C, herein, to obtain such compensation, CONTRACTOR/S shall submit to COUNTY invoices
that contain:
a. The Agreement Number assigned by COUNTY to this Agreement;
b. The Account Number, if any, assigned by COUNTY;
c. The date/s of service;
d. Full and complete descriptions of each service provided, if code is
unlisted, an additional descriptor would be provided for any unlisted code;
e. The cost of each service provided;
f. The CPT codes utilized to determine services provided;
g. The date/s and time/s Professional Medical Services were
provided, if any; and
h. The name, date of birth, MISP Number, and current contact
information of the MISP beneficiary who received such services.
Claims shall be submitted to COUNTY electronically or on a UB or HCFA-1500 claim form in
accordance with industry standards.
CONTRACTOR/S agree to submit invoices/claims to COUNTY for services referred under this
Agreement no later than ninety (90) days after the service was delivered or ninety (90) days after a
MISP beneficiary has been discharged from a CMC facility, whichever is later.
COUNTY agrees to pay CONTRACTOR/S, subject to the contingencies in Sections 3, A – 3, C,
herein, within forty-five (45) calendar days after receipt and verification of the invoices from
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CONTRACTOR/S. Invoices shall be submitted to County of Fresno, Department of Public Health, P.O
Box 11867, Fresno, CA 93775, Attention: DPH Director. This Agreement number must appear on all
invoices and correspondence relating to this Agreement. Invoices shall include the industry standard
coding to reflect the services provided and the billed charges for said services.
CONTRACTOR/S shall provide COUNTY with CONTRACTOR/S signed W -9 and CA 590 Forms
within thirty (30) days of the execution of this Agreement so that COUNTY may set up payment
mechanism in the COUNTY’S vendor payment system. CONTRACTOR/S shall provide updated Forms
annually and/or upon demand as payments will not be made to CONTRACTOR/S if current and correct
W-9 and CA 590 Forms are not on file with COUNTY and said payments will not be considered late if
Forms are not received by COUNTY as requested.
Alternatively, COUNTY understands that CONTRACTOR/S may not do their own invoicing for
services and CONTRACTOR/S agrees that they shall provide COUNTY’S DPH Director, or designee,
with the contact information and signed W -9 and CA 590 Forms of the CONTRACTOR/S’ billing
company within thirty (30) days of the execution of this Agreement. Should the CONTRACTOR/S
change billing companies during the contract period, CONTRACTOR/S shall notify COUNTY’S DPH
Director, or designee, within sixty (60) days of the change and shall provide contact information and a
signed W -9 and CA 590 Forms for the new billing company within sixty (60) days of the change.
COUNTY agrees that invoices submitted by CONTRACTOR/S shall be presumed to be coded
and billed correctly pursuant to the current Medicare regulations and guidance located at
https://www.cms.gov/Medicare/Medicare.html
4. TERM AND TERMINATION
A. Term: This Agreement shall become effective upon execution and shall terminate
at 11:59 p.m. on September 9, 2022.
1) Extension of Agreement: This Agreement may be extended by COUNTY
for up to seven (7) additional, successive twelve (12) month periods upon the same terms and
conditions set forth, herein. Each extension period will be contingent upon both Parties mutual consent
to continue this Agreement for the then successive twelve (12) month extension period at least sixty (60)
calendar days prior to each successive twelve (12) month extension period. The Director of the
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Department of Public Health, or his/her designee, is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR/S satisfactory performance.
Notwithstanding anything to the contrary in this Section 4, A, either Party may terminate this
Agreement in accordance with Section 4, B, below.
B. Termination:
1) Non-Allocation of Funds: The terms of this Agreement, and the services
to be provided thereunder, are contingent on the approval of funds by the appropriating government
agency. Should sufficient funds not be allocated, the services provided may be modified, or this
Agreement terminated, at any time, by giving CONTRACTOR/S at least ninety (90) calendar days
advance written notice.
2) Maximum Compensation not Extended: In the event CONTRACTOR/S
and COUNTY reach the maximum compensation limits and the COUNTY’S Board of Supervisors
affirmatively decides not to amend the Agreement to extend the maximum compensation limits in
Section 3, B, 5) herein, CONTRACTOR/S shall no longer be obligated to provide any service in this
Agreement, herein, and may terminate the Agreement immediately.
3) Suspension: If a substantial part of the services which CONTRACTOR/S
has agreed to provide hereunder is interrupted due to a catastrophic event beyond the control of
CONTRACTOR/S, COUNTY may elect to terminate this Agreement upon ten (10) days prior written
notice to CONTRACTOR/S.
4) Material Breach of Contract: Either Party may, upon issuing at least a
ninety (90) calendar day prior written notice to the other Party, suspend or terminate this Agreement in
whole or in party, where in the determination of the other Party that there is:
a. An illegal or improper use of funds;
b. A failure to comply with any term of this Agreement;
c. A substantially incorrect or incomplete report submitted to the
COUNTY;
d. Improperly performed service.
However, the defaulting Party shall have forty (40) calendar days from the receipt of notice to
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correct the basis for suspension or termination and resolve the dispute in accordance with Section 5
below. If so corrected to the reasonable satisfaction of the non-defaulting Party, this Agreement shall
continue according to the terms and conditions herein.
In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any
breach of this Agreement or any default, which may then exist on the part of the CONTRACTOR/S.
Neither shall such payment impair or prejudice any remedy available to the COUNTY with respect to the
breach or default. The COUNTY shall have the right to demand of CONTRACTOR/S the repayment to
the COUNTY of any funds disbursed to CONTRACTOR/S under this Agreement, which in the judgment
of the COUNTY, were not expended in accordance with the terms of this Agreement. CONTRACTOR/S
shall promptly refund any such funds upon demand.
5) Without Cause: Under circumstances other than those set forth above,
this Agreement may be terminated by either Party upon the giving of ninety (90) calendar days advance
written notice of an intention to terminate to the other Party. Upon termination or expiration of this
Agreement, each Party shall continue to remain liable for their own obligations or liabilities, as indicated
herein, originating prior to termination of this Agreement.
5. AGREEMENT DISPUTE RESOLUTION
If any claim, dispute, or controversy (any or all of which shall be hereinafter referred to as
“dispute”) shall arise between the Parties with respect to making, construction, terms, or interpretation of
this Agreement or any breach thereof, or the rights or obligations of any Party hereto, the Parties shall seek,
in good faith, to informally resolve their dispute/s to the maximum extent possible. If any dispute between
the Parties cannot be resolved informally within twenty (20) calendar days, the Parties may agree to settle
the dispute by nonbinding mediation, unless the Parties mutually agree otherwise. The mediator shall be
mutually selected by the Parties, but in the case of disagreement, the mediator shall be selected by lot from
among two (2) nomination provided by each Party. All costs and fees required by the mediator shall be
split equally by the Parties; otherwise, each Party shall bear its own cost of mediation. If mediation fails to
resolve the dispute within twenty (20) calendar days, each Party reserves the right to resolve the dispute in
any manner provided by law or in equity.
///
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6. MODIFICATION AND ASSIGNMENT
A. Modification: Any matters of this Agreement may be modified from time to time by
the written consent of all Parties without, in any way, affecting the remainder.
B. Non-Assignment: This Agreement is personal in nature and the rights or duties
hereunder shall not be transferred, delegated, or assigned by either Party, without the prior written
consent of the other Party.
C. Subcontractors: CONTRACTOR/S may subcontract the performance of certain
services of this Agreement to other third party agents, only if CONTRACTOR/S obtains the prior written
approval from COUNTY. Any subcontractors will be subject to all applicable provisions of this
Agreement, and all applicable State of California and Federal regulations. CONTRACTOR/S will be
responsible for informing any subcontractors, and requiring any subcontractors to comply with all the
terms and conditions of this Agreement and of all the Federal and State of California law requirements
incorporated herein. CONTRACTOR/S shall be responsible to COUNTY for the performance of any
subcontractor. The use of subcontractors by CONTRACTOR/S shall not entitle CONTRACTOR/S to
any additional compensation or other payment than is provided for under this Agreement.
7. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR/S under
this Agreement, it is mutually understood and agreed that CONTRACTOR/S, including any and all of
CONTRACTOR/S officers, agents, and employees will, at all times, be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR/S shall perform its work
and function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR/S is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR/S and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof.
Because of its status as an independent CONTRACTOR/S, CONTRACTOR/S shall have
absolutely no right to employment rights and benefits available to COUNTY employees. CONTRACTOR/S
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shall be solely liable and responsible for providing to, or on behalf of, its employees all legally-required
employee benefits. In addition, CONTRACTOR/S shall be solely responsible and save COUNTY harmless
from all matters relating to payment of CONTRACTOR/S employees, including compliance with Social
Security withholding and all other regulations governing such matters. It is acknowledged that during the
term of this Agreement, CONTRACTOR/S may be providing services to others unrelated to the COUNTY
or to this Agreement.
8. HOLD HARMLESS:
CONTRACTOR/S agrees to indemnify, save, hold harmless, and at COUNTY'S request,
defend the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR/S, its officers, agents, or
employees under this Agreement, and from any and all costs and expenses (including attorney’s fees and
costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who
may be injured or damaged by the performance, or failure to perform, of CONTRACTOR/S, its officers,
agents, or employees under this Agreement.
COUNTY agrees to indemnify, save, hold harmless, and at CONTRACTOR’S request, defend
CONTRACTOR/S, its officers, agents, and employees from any and all costs and expenses (including
attorney’s fees and costs), damages, liabilities, claims, and losses occurring or resulting to
CONTRACTOR/S in connection with the performance, or failure to perform, by COUNTY, its officers,
agents, or employees under this Agreement, and from any and all costs and expenses (including attorney’s
fees and costs), damages, liabilities, claims, and losses occurring or resulting to any person, firm, or
corporation who may be injured or damaged by the performance, or failure to perform, of COUNTY, its
officers, agents, or employees under this Agreement.
9. INSURANCE
Without limiting the COUNTY’S right to obtain indemnification from CONTRACTOR/S or any
third Parties, CONTRACTOR/S, at its sole expense, shall maintain in full force and effect, the following
insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
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A. Commercial General Liability: Commercial General Liability Insurance with limits of
not less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
Dollars ($4,000,000). This policy shall be issued on a per occurrence basis. COUNTY requires specific
coverages including completed operations, products liability, contractual liability, Explosion-Collapse-
Underground, and fire legal liability.
B. Automobile Liability: Comprehensive Automobile Liability Insurance with limits of not
less than One Million Dollars ($1,000,000) per accident for bodily injury and for property damages.
Coverage should include any auto used in connection with this Agreement.
C. Professional Liability: If CONTRACTOR/S employs licensed professional staff, (e.g.,
Ph.D., R.N., L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less
than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual aggregate.
D. Cyber Liability: Cyber Liability Insurance with limits not less than One Million Five
Hundred Thousand Dollars ($1,500,000) per occurrence or claim, Two Million Dollars ($2,000,000)
aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is
undertaken by CONTRACTOR/S in this Agreement and shall include, but not be limited to, claims
expenses resulting from claims made against CONTRCTOR/S for a data breach, security breach,
infringement of patent or software copyright or misappropriation of trade secrets; or penalties and claims
expenses because of a regulatory proceeding where CONTRACTOR/S is legally obligated to pay.
E. Worker's Compensation: A policy of Worker's Compensation insurance as may be
required by the California Labor Code.
F. Additional Requirements Relating to Insurance: CONTRACTOR/S shall obtain
certificates of insurance or endorsements to the Commercial General Liability insurance naming the County
of Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall
apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers,
agents and employees shall be excess only and not contributing with insurance provided under
CONTRACTOR/S policies herein. In the event that this insurance is cancelled or changed other than minor
changes incidental to a policy renewal, CONTRACTOR/S will provide written notice to COUNTY within
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thirty (30) days.
Within sixty (60) days from the date CONTRACTOR/S signs and executes this Agreement,
CONTRACTOR/S shall provide certificates of insurance as stated above for all of the foregoing policies,
as required herein, to the County of Fresno, Department of Public Health, P.O. Box 11867, Fresno,
California 93775, Attention: Contracts Section – 6th Floor, stating that such insurance coverage have
been obtained and are in full force; that such Commercial General Liability insurance names the County
of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but
only insofar as the operations under this Agreement are concerned; that such coverage for additional
insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by
COUNTY, its officers, agents and employees, shall be excess only and not contributing with insurance
provided under CONTRACTOR/S policies herein.
In the event CONTRACTOR/S fails to keep in effect at all times insurance coverage as herein
provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
Agreement upon the occurrence of such event.
All policies shall be issued by admitted insurers licensed to do business in the State of California,
and such insurance shall be purchased from companies possessing a current A.M. Best, Inc. rating of A
FSC VII or better or covered by a program of self-insurance.
10. AUDITS AND INSPECTIONS
CONTRACTOR/S shall, upon three (3) business days’ notice and during business hours,
and as often as the COUNTY may deem necessary, make available to the COUNTY for examination all of
its records and data with respect to the matters covered by this Agreement. CONTRACTOR/S shall, upon
request by the COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary
to ensure CONTRACTOR/S compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand Dollars ($10,000), CONTRACTOR/S shall be subject to
the examination and audit of the Auditor General for a period of three (3) years after final payment under
contract (Government Code Section 8546.7).
11. NOTICES
The persons and their addresses having authority to give and receive notices under this Agreement
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include the following:
COUNTY CONTRACTORS
COUNTY OF FRESNO SEE EXHIBIT 1
Director, County of Fresno
Department of Public Health
P.O. Box 11867
Fresno, CA 93775
///
All notices between the COUNTY and CONTRACTOR/S provided for or permitted under this
Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the Government Code,
beginning with section 810).
12. RECORDS
A. Upon CONTRACTOR/S commencement of provision of Professional Medical
Services, pursuant to this Agreement upon execution on September 10, 2019, CONTRACTOR/S agrees to
document services rendered to patients in medical records in accordance with all applicable State and
Federal laws, rules, and regulations for services performed at CMC and its affiliated hospitals and facilities.
Additionally, to the extent CONTRACTOR/S controls medical health record, CONTRACTOR/S agrees to
maintain and keep confidential adequate and complete medical health care records on each MISP
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beneficiary patient it serves pursuant to any applicable accreditation standards, State of California and
Federal laws and regulations.
B. CONTRACTOR/S shall maintain complete and accurate financial records with
respect to the services rendered herein. All such records shall be prepared in accordance with generally
accepted accounting procedures, shall be clearly identified, and shall be kept readily accessible and
available for inspection, as described in Section 9, Audits and Inspections, herein. All such records shall be
retained by CONTRACTOR/S and kept accessible as required by State of California and Federal law.
13. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A. COUNTY and CONTRACTOR/S each consider and represent themselves as
covered entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
Law 104-191 (HIPAA) and agree to use and disclose Protected Health Information (PHI) as required by
law.
COUNTY and CMC acknowledge that the exchange of PHI between them is only for treatment,
payment, and health care operations.
COUNTY and CMC intend to protect the privacy and provide for the security of PHI pursuant to the
Agreement in compliance with HIPAA, the Health Information technology for Economic and Clinical Health
Act, Public Law 111-005 (HITECH), and regulations promulgated thereunder by the U.S. Department of
Health and Human Service (HIPAA Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require CMC to enter into
a contract containing specific requirements prior to the disclosure of PHI, as set forth in, but not limited to
Title 45, Sections 164.314(a), 164.502(e), and 164.504(e) of the Code of Federal Regulations.
B. CONTRACTOR/S shall report to COUNTY, in writing, any knowledge or reasonable
belief that there has been unauthorized access, viewing, use, disclosure, security incident, or breach of
unsecured PHI not permitted by this Agreement of which it becomes aware, immediately and without
reasonable delay and in no case later than two (2) business days of discovery. Immediate notification shall
be made to COUNTY’S Information Security Officer and Privacy Officer and COUNTY’S DPH HIPAA
Representative, within two (2) business days of discovery. The notification shall include, to the extent
possible, the identification of each individual whose unsecured PHI has been, or is reasonably believed to
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have been, accessed, acquired, used, disclosed, or breached. CONTRACTOR/S shall take prompt
corrective action to cure any deficiencies and any action pertaining to such unauthorized disclosure
required by applicable Federal and State Laws and regulations. CONTRACTOR/S shall investigate such
breach and is responsible for all notifications required by law and regulation or deemed necessary by
COUNTY and shall provide a written report of the investigation and reporting required to COUNTY’S
Information Security Officer and Privacy Officer and COUNTY’S DPH HIPAA Representative. This written
investigation and description of any reporting necessary shall be postmarked within the thirty (30) working
days of the discovery of the breach to the addresses below:
County of Fresno County of Fresno County of Fresno
Dept. of Public Health Dept. of Public Health Internal Services Department
HIPAA Representative Privacy Officer Information Security Officer
(559) 600-6439 (559) 600-6405 (559) 600-5800
P.O. Box 11867 P.O. Box 11867 333 W. Pontiac Way
Fresno, CA 93775 Fresno, CA 93775 Clovis, CA 93612
///
14. GOVERNING LAW
Venue for any action arising out of or related to this Agreement shall only be in Fresno
County, California.
The rights and obligations of the Parties and all interpretation and performance of this Agreement
shall be governed in all respects by the laws of the State of California.
15. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR/S shall not unlawfully
discriminate against any employee or applicant for employment, or recipient of services, because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
sexual orientation, military status or veteran status pursuant to all applicable State of California and
Federal statutes and regulation.
16. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if CONTRACTOR/S is operating as a corporation (a for-
profit or non-profit corporation) or if during the term of the agreement, CONTRACTOR/S changes its
status to operate as a corporation.
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Members of the CONTRACTOR/S Board of Directors shall disclose any self-dealing transactions
that they are a party to while CONTRACTOR/S is providing goods or performing services under this
agreement. A self-dealing transaction shall mean a transaction to which CONTRACTOR/S is a party
and in which one or more of its directors has a material financial interest. Members of the Board of
Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit 6, and incorporated herein by
reference, and submitting it to the COUNTY prior to commencing with the self-dealing transaction or
immediately thereafter.
17. SEPARATE AGREEMENT
It is mutually understood by the Parties that this Agreement does not, in any way, create
a joint venture among the individual CONTRACTORS. By execution of the Agreement,
CONTRACTORS understand that a separate Agreement is formed between each individual
CONTRACTOR and COUNTY. CONTRACTORS further understand that COUNTY utilizes services of
other CONTRACTORS and that no single CONTRACTOR is guaranteed any specific amount of
compensation during each period of this Agreement.
18. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of any
one provision in the Agreement shall not affect the other provisions.
19. ADDITIONS/DELETIONS OF CONTRACTORS
COUNTY’S DPH Director, or designee, on behalf of the COUNTY, reserves the right, at
any time during the term of this Agreement, to add new contractors to those identified in Exhibit 1.
CONTRACTOR/S shall identify which Professional Medical Service they are licensed and CMC
credentialed to provide and agree to the service requirements identified in Exhibits 1 and 3 pertaining to
those specific licensed and CMC credentialed Professional medical Services, prior to being added to
this Agreement. It is understood that any such additions shall not affect the terms and conditions of this
Agreement with other CONTRACTORS and, therefore, such additions may be made by COUNTY’S
DPH Director or designee without notice to or approval of the other CONTRACTOR/S identified in
Exhibit 1. Deletions shall be made in writing by COUNTY’S DPH Director, or designee, to the particular
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CONTRACTOR/S to be deleted, or shall be in accordance with the provisions of Section 3 of this
Agreement.
20.SUPERSEDE
This Agreement shall supersede in its entirety and render null and void the Assignment of
Agreement for specialty professional medical services, including adult primary care services and
emergency care, to MISP beneficiaries between COUNTY and University Faculty Associates, Inc.,
identified as COUNTY Board Agreement No.14-677-1, which became effective November 16, 2015.
21.ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between CONTRACTOR/S and
COUNTY with respect to the subject matter hereof and supersedes all previous Agreement negotiations,
proposals, commitments, writings, advertisements, publications, and understanding of any nature
whatsoever unless expressly included in this Agreement.
///
///
///
///
///
///
///
////
///
///
///
///
///
///
///
///
1 IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the day and year first
2 hereinabove written.
3 CONTRACTORS:
SEE ATTACHTED SIGNATURE PAGE/S
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26 FOR ACCOUNTING USE ONLY:
Fund :
27 Org:
Account:
28
0001/10000
5240
7295
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COUNTY OF FRESNO:
Nathan Magsig, Chairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By :
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EXHIBIT 1
List of Contractors
Community Medical Imaging (CMI)
Sue Kelton, Chief Financial Officer
1867 E. Fir Ave., Suite 104
Fresno, CA 93720
(559) 325-5809
skelton@cmirad.com
Community Foundation Medical Group (CFMG)
Vicki L. Anderson, Vice President, Managed Care
7370 N. Palm Ave.
Fresno, CA 93711
vanderson@communitymedical.org
(559) 226-6800
Family HealthCare Network (FHCN)
Matt Miller, Managed Care Manager
305 E. Center Ave.
Visalia, CA 93291
memiller@fhcn.org
(559) 737-4925
University Faculty Associates, Inc. (UFA)
Isabel Stone, Contract & Reimbursement Specialist
2625 E. Divisadero St.
Fresno, CA 93721
Isabel.Stone@CCFMG.org
(559) 453-5200
UCSF Fresno Medical Education Group (UCSF –
Fresno)
Isabel Stone, Contract & Reimbursement Specialist
2625 E. Divisadero St.
Fresno, CA 93721
Isabel.Stone@CCFMG.org
(559) 453-5200
Central California Faculty Medical Group (CCFMG)
Isabel Stone, Contract & Reimbursement Specialist
2625 E. Divisadero St.
Fresno, CA 93721
Isabel.Stone@CCFMG.org
(559) 453-5200
Pathology Associates (PA)
Steven J. Frediani, Chief Operating Officer
305 Park Creek Drive
Clovis, CA 93611
SFrediani@pathology-associates.com
(559) 326-2752
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EXHIBIT 2
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EXHIBIT 3
Professional Medical Services
Emergency Department Medical Services
Inpatient Hospital Medical Services
Clinic Services/Specialty Medical Services including, but not limited to:
o Oral and Maxillofacial Surgery (OMFS)
o Non-elective Plastic Surgery
o Primary Care
o Endocrinology
o Neurology
o Pulmonology
o Cardiology
o Orthopedics
o Obstetrics and Gynecology
o Ears, Nose, and Throat (ENT)
o Dermatology
o Oncology
o Gastroenterology
o Ophthalmology
Other services that are Medi-Cal and MISP covered services that are mutually agreed upon between
Contractor/s and the County’s Department of Public Health Director.
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EXHIBIT 4
Participating Affiliated Hospitals and Facilities
Acute Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Regional Medical Center
2823 Fresno Street Tax I.D. # 94-1156276
Fresno, CA 93724 Medicare # 050060
(559) 459-6000 State License #040000096
Accredited by The Joint Commission NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Medical Center
2755 Herndon Avenue Tax I.D. # 94-1156276
Clovis, CA 93611 Medicare # 050492
(559) 324-4000 State License # 040000004
Accredited by The Joint Commission NPI # 1316027709
Fresno Community Hospital & Medical Center
d.b.a. Fresno Heart & Surgical Hospital
15 E. Audubon Drive Tax I.D. # 94-1156276
Fresno, CA 93720 Medicare # 050060
(559) 433-8000 State License # 0400000096
Accredited by The Joint Commission NPI # 1104906569
Cancer Service Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Cancer Institute (Inpatient) Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 NPI # 1104906569
(559) 459-6000
Fresno Community Hospital & Medical Center
d.b.a. California Cancer Center Tax I.D. # 94-1156276
785 N. Medical Center Drive West Medicare # 050060
Clovis, CA 93611 NPI # 1104906569
(559) 387-1802
Outpatient Dialysis Service Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Dialysis Center-Fresno Tax I.D. # 94-1156276
285 N. Fresno Street Medicare # 05-3525
Fresno, CA 93701 NPI #1821179656
(559) 459-3901
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EXHIBIT 4 (continued)
Participating Affiliated Hospitals and Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Regional Outpatient Dialysis Center Tax I.D # 94-1156276
215 N. Fresno Street, Suite 150 Medicare # 05-3524
Fresno, CA 93701 NPI # 1497836613
(559) 459-6000
Home Health Services
Fresno Community Hospital & Medical Center
d.b.a. Community Home Care Tax I.D. # 94-1156276
1630 E. Shaw Avenue, Suite 172 Medicare #05-7248
Fresno, CA 93710 NPI # 1588745137
(559) 724-4242
Fresno Community Hospital & Medical Center
d.b.a. Community Home Infusion Tax I.D. # 77-0175659 (Home 1630 E.
Shaw Avenue, Suite 172 Therapy & Pharmacy)
Fresno, CA 93710 Medicare # 019553002
(559) 724-4242 NPI # 1669553129
Outpatient Imaging Service Facilities
Community Regional Medical Center Imaging
2823 Fresno St.
Fresno, CA 93721
(559) 459-2800
Clovis Community Medical Center
2755 E. Herndon Ave.
Clovis, CA 324-4048
Radin Breast Care Center
(559) 324-4444
Fresno Heart & Surgical Hospital
15 East Audubon Drive
Fresno, CA 93720
(559) 433-8000
Infusion Therapy (Outpatient) Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Ambulatory Infusion Center Tax I.D. # 94-1156276
2335 E. Kashian Lane, Suite 110 Medicare # 050060
Fresno, CA 93701 NPI # 1104906569
(559) 459-6000
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EXHIBIT 4 (continued)
Participating Affiliated Hospitals and Facilities
Fresno Community Hospital & Medical Center
d.b.a. Infusion Clinic @ Ambulatory Infusion Center-Clovis Tax I.D. # 94-1156276
729 Medical Center Drive, Suite 215 Medicare # 050060
Clovis, CA 93611 NPI # 1104906569
(559) 324-4000
Medical Rehabilitation Services Facilities
Fresno Community Hospital & Medical Center
d.b.a. Leon S. Peters Rehabilitation Center (Inpatient) Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 NPI # 1679654404
(559) 459-6000
Fresno Community Hospital & Medical Center
d.b.a. Community Outpatient Rehabilitation Center
Outpatient Neurological Training, PT, OT, ST, and Lymphedema Therapy
215 N. Fresno Street, Suite 250 Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 324-4057 NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Hospital & Medical Center
Outpatient Physical Therapy Tax I.D. # 94-1156276
688 Medical Center Drive, Suite 101 Medicare # 050492
Clovis, CA 93611 NPI # 1316027709
(559) 324-4057
Pharmacy (Off-Site/Outpatient)
Community Health Enterprises
d.b.a. Care Center Pharmacy Tax I.D. # 77-0175659
1570 E. Herndon Avenue Medicare # 0194440002
Fresno, CA 93720 NABP # 05-69042
(559) 437-7370 NPI # 1497813901
Ambulatory Clinic Facilities
Fresno Community Hospital & Medical Center
d.b.a. Deran Koligian Ambulatory Care Center
290 N. Wayte Lane Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 459-4900 NPI # 1104906569
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EXHIBIT 4 (continued)
Participating Affiliated Hospitals and Facilities
Family HealthCare Network
d.b.a. Deran Koligian Ambulatory Care Center
290 N. Wayte Lane Tax I.D. # 94-2525145
Fresno, CA 93701 Medicare #921087
(559) 459-4900 NPI # 1225546575
Fresno Community Hospital & Medical Center
d.b.a. North Medical Plaza
215 N. Fresno Street, Suites 230 & 370 Tax I.D. # 94-1156276
Fresno, CA 93701 Medicare # 050060
(559) 459-4900 NPI # 1104906569
(Services Provided: Diabetes Center and Pediatric Specialty Department ONLY)
Urgent Care/Emergency Room Facilities
Fresno Community Hospital & Medical Center
d.b.a. Community Regional Medical Center Tax I.D. # 94-1156276
2823 Fresno Street Medicare # 050060
Fresno, CA 93721 State License # 040000096
(559) 459-6000 NPI # 1104906569
Fresno Community Hospital & Medical Center
d.b.a. Clovis Community Hospital & Medical Center Tax I.D. # 94-1156276
2755 Herndon Avenue Medicare # 050492
Clovis, CA 93611 State License # 040000096
(559) 324-4000 NPI # 1316027709
Subacute Center (Medical Ventilation)
Fresno Community Hospital & Medical Center
d.b.a. Community Subacute and Transitional Care Center Tax I.D. # 94-1156276
3003 N. Mariposa St. Medicare # 055258
Fresno, CA 93703 State License # 040000096
(559) 459-1711 NPI # 1104906569
Services may be provided at other CMC facilities within Fresno County as determined by CMC and agreed
upon by the County’s Department of Public Health Director.
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EXHIBIT 5
Reimbursement for Specialty, Primary, and/or Emergency Care Professional Medical Services
Claims shall be submitted using the most recent version of Current Procedural Terminology (CPT) codes.
COUNTY will pay CONTRACTOR/S on a fee-for-service basis, one hundred percent (100%) of Medicare’s
Resource Based Relative Value Scale (RBRVS) for the Area 56 in effect at the time the service for CPT
codes submitted under the following categories indicated below:
CPT Code Allowed:
Medicine 100% of Medicare allowable Area 56
Surgery 100% of Medicare allowable Area 56
Radiology 100% of Medicare allowable Area 56
Pathology 100% of Medicare allowable Area 56
Family Practice 100% of Medicare allowable Area 56
All other Medical Service 100% of Medicare allowable Area 56
Unlisted Procedures 65% of billed charges
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EXHIBIT 6
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members of a contractor’s board of directors
(hereinafter referred to as “County Contractor”), must disclose any self-dealing transactions that they are a party to while providing goods,
performing services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one or more of
its directors has a material financial interest .”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self -dealing transaction that is being disclosed to t he County. At a
minimum, include a description of the following:
a. The name of the agency/company with which the Corporation has the transaction; and
b. The nature of the material financial interest in the Corporation’s transaction that the board
member has.
(4) Describe in detail why the self -dealing transaction is appropriate based on applicable provisions of the
Corporations Code.
Form must be signed by the board member that is involved in the self -dealing transaction described in Sections
(3) and (4).(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
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(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: